The Controversy About the Effects of Different Doses of Corticosteroid Treatment on Clinical Outcomes for Acute Respiratory Distress Syndrome Patients: An Observational Study.

Jin-Fu Xu,Wen-Wen Wang,Zong-Mei Wen,Yuan-Lin Song,Hai-Wen Lu,Ping Jiang,Li Zhang,Bei Mao,Jia-Wei Yang

doi:10.3389/fphar.2021.722537

Abstract

Background: Corticosteroid usage in acute respiratory distress syndrome (ARDS) remains controversial. We aim to explore the correlation between the different doses of corticosteroid administration and the prognosis of ARDS.Methods: All patients were diagnosed with ARDS on initial hospital admission and received systemic corticosteroid treatment for ARDS. The main outcomes were the effects of corticosteroid treatment on clinical parameters and the mortality of ARDS patients. Secondary outcomes were factors associated with the mortality of ARDS patients.Results: 105 ARDS patients were included in this study. Corticosteroid treatment markedly decreased serum interleukin-18 (IL-18) level (424.0 ± 32.19 vs. 290.2 ± 17.14; p = 0.0003) and improved arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (174.10 ± 65.28 vs. 255.42 ± 92.49; p < 0.0001). The acute physiology and chronic health evaluation (APACHE II) score (16.15 ± 4.41 vs. 14.88 ± 4.57, p = 0.042) decreased significantly on the seventh day after systemic corticosteroid treatment. Interestingly, the serum IL-18 decreased significantly (304.52 ± 286.00 vs. 85.85 ± 97.22, p < 0.0001), whereas the improvement of PaO2/FiO2 (24.78 ± 35.03 vs. 97.17 ± 44.82, p < 0.001) was inconspicuous after systemic corticosteroid treatment for non-survival patients, compared with survival patients. Furthermore, the receiver operating characteristic (ROC) model revealed, when equivalent methylprednisolone usage was 146.5 mg/d, it had the best sensitivity and specificity to predict the death of ARDS. Survival analysis by Kaplan–Meier curves presented the higher 45-day mortality in high-dose corticosteroid treatment group (logrank test p < 0.0001). Multivariate Cox regression analyses demonstrated that serum IL-18 level, APACHE II score, D-dimer, and high-dose corticosteroid treatment were associated with the death of ARDS.Conclusion: Appropriate dose of corticosteroids may be beneficial for ARDS patients through improving the oxygenation and moderately inhibiting inflammatory response. The benefits and risks should be carefully weighed when using high-dose corticosteroid for ARDS.Trial registration: This work was registered in ClinicalTrials.gov. Name of the registry: Corticosteroid Treatment for Acute Respiratory Distress Syndrome. Trial registration number: NCT02819453. URL of trial registry record: https://register.clinicaltrials.gov.

Highlights

Acute respiratory distress syndrome (ARDS) is caused by an acute inflammatory injury to the lung, associated with increased pulmonary vascular permeability
A total of 105 ARDS patients caused by severe pulmonary infection, who all received systemic corticosteroid treatment, were included in this study. 85 patients (80.95%) were male, The APACHE II score was 15.52 ± 5.08, and the SOFA score was 4.90 ± 1.94 at baseline. 67 patients (63.81%) were admitted to the intensive care unit (ICU) and 47 patients (44.76%) received mechanical ventilation
We found that after adjusting for confounding factors, high-dose corticosteroid treatment was an independent risk factor for death of ARDS patients

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is caused by an acute inflammatory injury to the lung, associated with increased pulmonary vascular permeability. The improvement in oxygenation and reduction of the duration of mechanical ventilation in ARDS patients followed by corticosteroids administration have been reported in previous randomized controlled clinical trials (RCTs), but there was no conclusive evidence of lower mortality in these patients (Meduri et al, 1998; Steinberg et al, 2006; Meduri et al, 2007). A published RCT has revealed that early administration of dexamethasone could reduce the duration of mechanical ventilation and overall mortality of moderate-tosevere ARDS patients (Villar et al, 2020). The dose, duration, and timing of corticosteroid administration for ARDS patients remain controversial, which has prompted us to do further research.

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